Test 2 Flashcards
Abortion: Types, S/Sx
Elective or spontaneous
No fetal viability before 20weeks
S/sx:
Uterine Cramping
Vaginal Bleeding - bright red
Pelvic Pressure
Backache
Ecotopic Pregnancy: What it is, S/Sx, Treatment
Fertilized ovum outside uterus in fallopian tube
S/Sx:
UNILATERAL, sharp abdominal pain
Normal pregnancy symptoms
positive pregnancy test
If suspected you can perform gentile uterine palpitation
Treatment:
NPO if surgery (sometimes sent home on methotrexate)
VS
Monitor for signs of bleeding, including Cullen Sign
Type and Crossmatch blood
Molar Pregnancy
Degenerative placenta, fertilized egg without embryo but incorrect chromosomes
Characterized by grape-like clusters
S/Sx:
Preeclampsia prior to 20 weeks
NO FHT or skeleton
hCG continues to rise when it should decline
Abnormal uterine bleeding
Uterus larger than dates
Anemia from blood loss
Excessive vomiting
Abdominal cramping
Treatment:
- Prep for D&C
- Monitor hCG levels for 1-year: monthly for first 6-months then every 2 months for 6-months
-No pregnancy for 12-months as pregnancy can mask symptoms of chorioncarcinoma
- Possible prophylactic chemo
Placenta Previa: S/Sx, Management
Placenta is implanted in lower uterus instead of fundus due to uterine scarring, surgery or fibroid tumor
Usually occurs in 3rd trimester
S/Sx:
PAINLESS
bright red bleeding
uterus is soft
Possible signs of shock
Abnormal FHR
Treatment
Best rest - sent home after 48-hours if no bleeding
<36 weeks may be monitored in hospital
>36 weeks may deliver
Interventions
side-lying position
NO leopold or vaginal/rectal exams
monitor VS every 15 minutes
IV fluids - 2 large bore IVs
Use external monitor for contractions and FHR
Type Cross match blood for delivery
Placenta Abruption: S/Sx, Treatmetn
Premature separation of placenta from uterine wall
Medical emergency late in 3rd trimester
Risk increased with HTN, high gravidity, trauma, short umbilical cord or cocaine
S/Sx
Rigid, board-like abdomen
Pain WITH epidural
Medical Management:
Best Rest
External monitoring only
Labs: CBC, PT, aPTT, INR
Nursing Interventions:
VS q15
Side-lying position
2 large bore IVs
Prep for c-section
Monitor blood loss, save all pads, linens
Monitor for DIC
Signs of DIC
bleeding gums or nose
reduced lab values for platelets and prothrombin
Bleeding from IV sites
Ecchymosis
Gestational Diabetes: What’s happening, risks?
Hormonal changes increase maternal insulin resistance to ensure baby has enough glucose
Insulin resistance due to placental hormones (insulinase and cortisol)
Moms are more prone to preeclampsia, hemorrhage, infection, hydroaminos and macofetus
Glucose Tolerance Test
Performed at 24-26 weeks
No need for fasting
1-hr:
- 50g glucose given and blood sugar checked at 1hr, if greater than 140 then 3-hr test performed
3hr:
- 100g glucose given and if 2 or more values are met or exceeded then this indicates positive
Insulin Needs by Trimester
First Trimester: Decreased
Second/Third: Increased due to placental hormones
GDM: First Trimester Risks
Uncontrolled glucose is a teratogen and may result in cardiac malformation
Macroscopic Fetus
> 4000g
May cause prolonged 2nd labor stage, head injury or shoulder dystocia
If C-section, then baby may have respiratory distress due to absence of vaginal squeeze
Baby may experience hypoglycemia
Respiratory Distress in GDM
Caused by decreased surfactant
Increased risk ventilation or supplemental oxygen
Neonatal Hyperproliferation of Pancreas
Enlarged pancreas due to high maternal glucose which causes increased insulin needs in fetus, but when umbilical cord is cut then no constant source of glucose but pancreas continues to put out high levels of insulin
Resolves in 4hrs, but if baby is >5000g then it can take a week
Pregnancy Testing for GDM
Ultrasound, nonstress tests and biophysical profiles
NST tests in 32-weeks and 2x weekly
In GDM, what happens in 3rd stage of labor to mom?
Insulin requirements drop substantially in first 24-hours, recommended to discontinue long acting insulin before delivery.
Mom recommended to breast feed for better glucose control
Hospital Care:
5% glucose infusion
Monitor ketones
monitor hemorrhage
Fetal Lung Maturity
Based on LS - lecithin:sphingomyelin ratio
Accounts for AFV changes
Considered mature if ratio >2.2 or if PG (phosphatidyglycerol) is present in surfactant past 36 weeks
Hyperemesis in pregnancy: S/Sx, Medication, Assessment, Nutrition
S/Sx:
Weight loss
dehydration
dry mucus membrane
decreased bp
increase pr
poor skin turgor
Medication: diclegis, compazine, zofran, phenergan
Assessment: ask about frequency, duration, and severity
May require TPN
When is nausea abnormal in pregnancy?
If it is excessive or prolonged vomiting with weight loss, electrolyte imbalance, nutritional deficiencies and ketonuria
Hypothyroid
Increased risk of infertility and miscarriage
S/Sx:
cold intolerance
lethargy
decreased exercise tolerance
weight gain
Medication: levothyroxine (synthroid)
Hyperthyroid
S/Sx:
Heat intolerance
diaphoresis
fatigue
anxiety
emotional instability
tachycardia >100bpm
Chronic HTN
HTN before pregnancy of prior to 20 weeks
Gestational HTN
HTN after 20 weeks w/o systemic features
Eclampsia: S/Sx, treatmetn
Pregnancy HTN w/ seizures
S/Sx
Persistent headache, blurred vision, epigastric/RUQ pain, AMS, SEIZURE
Medication: MgSO4 before and 24-hours post if no signs of toxicity;
Treatment:
Side- lying position
oxygen
MgSO4 Toxicity
Therapeutic Range: 4-7 mg/dL
MgSO4 also hs increase risk of post partum hemorrhage has it relaxes muscles and uterus not able to contract
S/Sx:
ABSENT DTR
Decrease RR
Diaphoresis/flushing
Warmth
EKG Changes
Decreased UOP but increase in mag level
Antidote: calcium gluconate
